Wilkinson Jordan Earl, O'Connor Michael, van den Hurk Maud, Phoenix Eimear, Kelly Linda, Roddy Darren, Levins Kirk, Dolan Roisin
Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
Department of Medicine, Royal College of Surgeons, Ireland.
J Hand Microsurg. 2024 Jul 5;16(5):100121. doi: 10.1016/j.jham.2024.100121. eCollection 2024 Dec.
This study aims to assess the cervical spine positioning of consultant and trainee hand surgeons during standardised hand surgeries, focusing on the prevalence of sustained end-range postures, particularly cervical spine flexion.
Surgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity.
We examined hand surgeons of all experience levels during 40 common hand surgery procedures. We used real-time dynamic goniometric measurements of neck flexion using the "UPRIGHT GO 2" device and accompanying smartphone app. Neck flexion exceeding 40° was used as the threshold for defining an acceptable neck position.
Analysis included 20 total subjects at various levels of medical training (SHO n = 6, Registrar n = 9, Consultant n = 5) performing surgeries under different conditions. Maladaptive neck positions were prevalent, with junior surgeons exhibiting such postures for 71 % of procedure time compared to 60 % for consultants. This underscores the potential contribution of sustained end-range postures to cervical spine dysfunction in hand surgeons, highlighting an early intervention opportunity. Notably, participants reported varied experiences with neck pain and expressed unanimous interest in integrating biofeedback posture devices into surgical training, with a single consultant expressing reservations.
本研究旨在评估专科和实习手外科医生在标准化手部手术过程中的颈椎位置，重点关注持续终末位姿势的发生率，尤其是颈椎前屈。
外科医生经常进行需要长时间维持特定姿势的手术。手外科医生可能面临更高的持续终末位姿势风险，尤其是颈椎前屈。这可能导致颈部肌肉骨骼结构的劳损。最近的证据表明，手外科医生颈部功能障碍的发生率更高，进而导致相关的发病率。
我们在40种常见的手部手术过程中对所有经验水平的手外科医生进行了检查。我们使用“UPRIGHT GO 2”设备及配套的智能手机应用程序对颈部前屈进行实时动态角度测量。将超过40°的颈部前屈用作定义可接受颈部位置的阈值。
分析纳入了20名处于不同医学培训水平的受试者（住院医师n = 6、专科住院医师n = 9、顾问医师n = 5），他们在不同条件下进行手术。适应不良的颈部姿势很普遍，初级外科医生在手术时间的71%呈现出此类姿势，而顾问医师为60%。这凸显了持续终末位姿势对手外科医生颈椎功能障碍的潜在影响，突出了早期干预的机会。值得注意的是，参与者报告了不同的颈部疼痛经历，并一致表示有兴趣将生物反馈姿势设备纳入手术培训，只有一位顾问医师有所保留意见。
